Recent advances in computational cardiac modeling have enabled simulations with increasing physiological accuracy and clinical relevance. These models facilitate patient-specific analysis, allowing for non-invasive investigations of pathological conditions such as myocardial fibrosis in dilated cardiomyopathy (DCM).
This study presents personalized electromechanical simulations for a patient with non-ischemic DCM, focusing on the mechanical consequences of myocardial fibrosis. Biventricular geometry and fibrosis regions were reconstructed from cardiac magnetic resonance imaging and used in simulations that account for the passive and active mechanical behavior of the tissue, coupled to a lumped parameter model to describe the circulatory system. Parameters were calibrated to match the patient's left ventricular ejection fraction (LVEF), enabling simulations of the full cardiac cycle under two conditions: (1) homogeneous tissue properties, and (2) localized fibrosis modeled as non-contractile and stiffer than healthy myocardium.
Pressure-volume loops were comparable in both scenarios, with a higher LVEF in the homogeneous case. However, mechanical indices revealed notable differences. Longitudinal strain and fiber stress were markedly reduced throughout the fibrotic model. These findings align with clinical echocardiographic observations and support the hypothesis that fibrosis alters local strain patterns, potentially driving progressive ventricular remodeling.
The proposed workflow enables the integration of patient-specific anatomy and function into biomechanical models, offering a non-invasive method to evaluate the impact of myocardial heterogeneities. This approach may enhance risk stratification and therapy planning for heart failure patients, especially in contexts where invasive assessment is not feasible.